![]() X-rays. X-rays provide images of dense structures, such as bone. The doctor may also ask your child to lie down to see if this straightens the curve - a sign that the curve is flexible and may be representative of postural kyphosis. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010 Reproduced from JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 4. This irregular shape causes the vertebrae to wedge together toward the front of the spine, decreasing the normal disk space and creating an exaggerated forward curvature in the upper back. In a patient with Scheuermann's kyphosis, an X-ray from the side will show that, rather than the normal rectangular shape, three or more consecutive vertebrae have a more triangular shape. Scheuermann's kyphosis is caused by a structural abnormality in the spine. However, Scheuermann's kyphosis can result in a more severe deformity than postural kyphosis. Like postural kyphosis, Scheuermann's kyphosis often becomes apparent during the teen years. ![]() Scheuermann's kyphosis is named after the Danish radiologist who first described the condition. It is rarely painful, and, because the curve does not progress, it does not usually lead to problems in adult life. Postural kyphosis is more common in girls than boys. The curve caused by postural kyphosis is typically round and smooth and can often be corrected by the patient when they are asked to stand up straight. It is noticed clinically as poor posture or slouching but is not associated with severe structural abnormalities of the spine. Postural kyphosis, the most common type of kyphosis, usually becomes noticeable during adolescence. The three that most commonly affect children and adolescents are: This experience supports the appositeness of the de-escalation of care asserted by the guidelines.Ītlantoaxial instability Down syndrome Os odontoideum Screening guidelines.There are several types of kyphosis. Routine radiographic screening may not be sufficiently predictive of DS individuals at risk to develop AAI. She was diagnosed and treated for atlantoaxial subluxation associated with os odontoideum. Our exemplary patient presented to the emergency department for neck pain without a history of significant trauma. The clinical experience of the Sie Center demonstrates that even when limiting imaging to patients who show signs or symptoms of spine pathology, the vast majority of x-rays are negative. We also report an illustrative case of a 5-year-old female with Down syndrome who presented with instability after normal screening radiographs per the pre-2011 guidelines. We reviewed the courses of patients with DS seen at the Sie Center for Down Syndrome at Children's Hospital Colorado who were evaluated for cervical spine disease and determined whether screening radiographic imaging could have led to earlier diagnosis or prevented development of neurological deficits. We provide the first neurosurgical review of a large experience implementing the 2011 AAP guidelines. An assessment of whether this alteration has been associated with an increase in AAI-associated spinal cord injury has not been undertaken. In 2011, the American Academy of Pediatrics (AAP) updated its AAI screening guidelines for children with DS from radiographic screening to radiographs only if there are clinical symptoms suggestive of cervical spine pathology. ![]() Atlantoaxial instability (AAI) has a higher incidence rate among individuals with Down syndrome (DS) than the non-DS population.
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